HomeMy WebLinkAboutMack Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ID =_ [ Permit Number:
U, LCC E L1' ` � pp Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
)(� k
PROPOSED IMPRO EMENT LOCATION: ��gg
Address:
Property Tax ID #3� l `� ��
v Lot Nolo 4
0
Site Plan Name: k Block No.
Project Name: 0 �-
DETAILED DESCRIPTION OF WORK:
. — F"
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors Pond
Electric P mbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Constructio c) Sq. Ft. of First Floor:
Cost of Construction: $ I ,��" Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam
Address: j ll� �'-
Name: _
Company:
City: State:
Zip Code: Fax: �
Phone No.
Add ess: Ck
911
City Stat
Zip Code: Fax: .3
Phone N� - 0 V
Y
E-Mail e. `5 A-ih6
_
E-Mail D Q
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
tate or C o u n ty icense C&
3Q'3Y
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIG GINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Nam
Name:
A ss:
Address:
Cit +r' tate•
City: State:
Zip. S Phone SCe
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie my nd posted o the jobsite before the first inspection. If you intend to obtain financing, consult
wit ender or a r efore commencing work or recording our Notice of Commencement.
Signa ure o n L s Contractor as Agent for Owner
STAT F F iDA
COUNTY OF �1 Q
Physical
Sw (or affir ed) and subscribed before me of Presence or Online Notarization
thim— day of , 20 )J by
�jw 44_�
Name of person making/statement.
Personally Known ✓ OR Produced Identification
e of Identificati d
(Signa of N 6tary Public- State of Florida)-JENNIFER L. BURCj;EAL3Ll a
ire
V Y COMMISSION # GG 227073
Commission No. (Seal) - XPIRES: July 15, 2022
+. Thru Notary Public undmr rar-it�t �
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Nev 5720/21